In a nutshell
This study investigated the effects of ranolazine (Ranexa), nicorandil (Ikorel), and ivabradine (Corlanor) on angina. The main finding was that ranolazine and ivabradine reduced angina and nicorandil reduced microvascular resistance.
Some background
There are many drugs approved for the treatment of angina. These include ranolazine, nicorandil, and ivabradine. Different drugs have different effects on different patients. Coronary flow reserve (CFR), index of microvascular resistance (IMR), and myocardial perfusion reserve index (MPRI) are commonly measured when evaluating the effects of these drugs.
CFR is the maximum increase in blood flow through the coronary arteries above the normal resting volume. IMR is a method for evaluating the circulation of blood in the small vessels of the heart. MPRI is used to measure how severe any damage to the heart tissue is. It is important to compare the effectiveness of different drugs for angina.
Methods & findings
This study analyzed 9 clinical trials investigating the effects of anti-anginal drugs on CFR, IMR, and MPRI. Overall, 650 patients were included.
Ranolazine, nicorandil, and ivabradine did not increase CFR compared to control drugs. Ranolazine did not increase the average MPRI. However, in patients whose CFR was less than 2.5 or had an average MPRI less than 2 before treatment, ranolazine increased the average MPRI. Ranolazine improved MPRI in the muscles in the middle of the heart.
Nicorandil reduced IMR, improving the function of the coronary blood vessels. Ranolazine and ivabradine were found to reduce angina pain and improved quality of life.
The bottom line
The main finding was that ranolazine improved MPRI and nicorandil reduced the IMR. In addition, the authors showed that ivabradine and ranolazine improved angina.
The fine print
This study compared the results of multiple clinical trials. Therefore the findings may have been influenced by the interpretation of different investigators.
What’s next?
If you have queries about the management of angina, please consult a doctor.
Published By :
Clinical therapeutics
Date :
Sep 20, 2019
